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ALLOSENSITIZATION AND LVAD: IT’S IN THE BLOOD—ABROGATION OF HLA ALLOSENSITIZATION BY TRANSFUSION WITH LEUKOREDUCED, ABO IDENTICAL BLOOD PRODUCTS.
Myra Coppage MS , Neil Blumberg MD , Leway Chen MD , Todd Massey MD , Jean Heuther MSN , Martin Zand MD, PhD , Nufatt Leong BS and Thomas Shanahan PhD . Rochester NY, University of Rochester Medical Center, 14642, Departments of Pathology, Cardiac Transplantation, and Medicine .
Use of ventricular assist device (VAD) prior to cardiac transplantation increases risk for HLA allosensitization secondary to transfusion, and may increase wait time for a compatible graft. Evidence from randomized trials in leukemia suggests that use of leukoreduced blood and ABO identical platelets reduces allosensitization. We established a protocol mandating use of leukoreduced and ABO identical products in patients receiving a VAD. Method: From September 2001 to present, 15 patients underwent VAD placement. All received blood products including FFP mean=19 (6-50), platelets mean=31 units (9-55), RBC mean=47 units (12-165). Prior to implantation PRA was determined by both CDC and ELISA (Quickscreen; GTI). Post-implantation recipients were monitored biweekly for anti-HLA antibodies. When a donor became available a crossmatch was performed by both CDC and FACS. Results: All 15 recipients demonstrated 0% CDC-PRA and negative ELISA prior to implantation. One patient received a heart within 8 days of LVAD with negative CDC and FACS crossmatch. None of the patients demonstrated CDC-PRA by 60 days post-LVAD. Half had positive reactions in the ELISA at 30 days and 10/11 were positive by 60 days. However no anti- HLA specificity was identified; these sera gave positive ELISA reactions even in no-antigen control wells. Ten recipients were transplanted. All 10 had negative CDC crossmatches, but 3/10 demonstrated reactivity in the FACS crossmatch. One patient died with a bivad (Thoratecs). 9/10 transplanted recipients are alive with functioning grafts. Conclusion: The use of leukofiltered and ABO identical blood products reduces the risk of allosensitization in VAD recipients.